%0 Journal Article
%T The Ethics of Reversibility: Why High-Stakes Clinical Decisions Need Paths Back
%A Wouter De Smet
%A Liesbeth Van Dam
%A Pieter Janssens
%J Asian Journal of Ethics in Health and Medicine
%@ 3108-5059
%D 2026
%V 6
%N 1
%R 10.51847/h9JnnsVY3Q
%P 153-161
%X High-stakes clinical decisions are usually evaluated through familiar ethical categories: informed consent, capacity, shared decision making, proportionality, best interests, and respect for autonomy. Less attention is given to whether the decision pathway itself preserves a meaningful opportunity to reconsider before options, bodily states, information, or time are irretrievably lost. This article develops a normative decision-design account of clinical reversibility. It distinguishes the technical reversibility of an intervention from the broader reversibility of a decision pathway and analyzes four dimensions: temporal, biological, procedural, and informational. Reversibility is defended as a pro tanto moral value because it can protect diachronic autonomy, accommodate uncertainty, permit learning, and require renewed justification for continuation rather than treating initial authorization as indefinitely sufficient. The article then proposes a qualitative classification of high-stakes decisions according to the degree of meaningful revisability available and the seriousness of the losses at stake. Time-limited trials, explicit pause points, and planned reassessment are examined as existing or extendable decision-design strategies, not as universally appropriate solutions. The account also recognizes decisions in which meaningful reversal is impossible or itself harmful. Reversibility therefore does not function as an absolute duty, validated metric, or substitute for substantive clinical judgment. Its ethical relevance depends on urgency, expected benefit and burden, relational authority, institutional capacity, and the consequences of delay. The central proposal is that high-stakes care should ask not only whether a choice is authorized now, but whether its design preserves a defensible path for justified reconsideration later.
%U https://smerpub.com/article/the-ethics-of-reversibility-why-high-stakes-clinical-decisions-need-paths-back-fep9allbvegpmgt